Assignment: Evaluating Compliance Strategies
Medical billing and coding is a lot more detailed and difficult that many people outside of the medical field know. Because there are so many different codes and the numbers of different insurance companies, Medicare and Medicaid all have different codes among themselves it can become overwhelming for the billing staff in offices to make sure that everything is right. Unfortunately all the codes have to be correct in order for doctors and hospitals to get paid in a timely manner. All medical billing is started the same way though.
A patient comes in to the doctor’s office and checks in. At this time, the front desk asks if they have insurance and if they do, make a copy of their insurance card. The staff member asks any questions involving payment at this time to make sure that they receive all the correct information that they can. Then the patient sees the doctor after this process. The doctor determines what the patient came in for and makes diagnoses at this time and writes down the information on the patients chart. The chart then comes through to the billing and coding department and the staff looks at what the doctor put in the chart and assigns different codes depending on what they see in the chart. This is where it can get complicated for the billing and coding department, because each individual insurance company has their own billing codes, so the staff member has to know what insurance to bill and make sure that the code is right and that the insurance will cover the procedure. Medicare and Medicaid also have their own separate codes.
The billing staff at an office must enter the correct CPT or Current Procedural Terminology and also explain not only what procedures where done, but why there were done. This can be overwhelming, and the biggest complaint insurance companies make is that the records are incomplete and are returned for further...
References: Austin, Andrea. Evaluating Compliance Strategies in Medical Coding. Oct. 12, 2009 Retrieved September 27, 2010 http://www.ehow.com/way_5519814_evaluating-compliance-strageties-medical-coding.html
Oklahoma University Billing Compliance Office http://www.ouhsc.edu/bc
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